NRMP Match Rank List: 7 Myths Debunked

Ranking programs is an intensely personal process. It’s a time of introspection to figure out what is really important , prestige, location, cost of living, just to name a few considerations. Throw in a couples match or a prelim year, and you have even more layers to consider.

Do not take the NRMP Rank List lightly , this ultimately determines where you match and where you’ll be spending the next 3-7 years of residency.

The 2025 Main Residency Match was the largest in history, with 52,498 registered applicants competing for 43,237 certified positions, according to the NRMP. Despite those numbers, 73.2% of matched U.S. MD seniors landed one of their top three choices. That’s nearly three out of four students getting a top-three pick, which tells you the system works when you use it correctly.

Here are seven common myths about creating your Rank Order List, including the truth about what you should be doing instead.

1. Myth: Rank programs in order of where you think you’ll match.

Truth: Rank programs in order of your true preference.

This is the most pervasive and most damaging myth in the Match. It stems from a fundamental misunderstanding of how the algorithm actually works , so let’s clear that up.

The NRMP uses a variant of the Gale-Shapley Deferred Acceptance Algorithm. The work behind this algorithm won Lloyd Shapley and Alvin Roth the Nobel Prize in Economics in 2012. Here’s what matters: the algorithm is applicant-proposing, meaning it starts with your preferences, not the programs’.

The algorithm attempts to place you into the program you ranked #1. If that program also ranked you and has space (or prefers you over someone tentatively matched), you’re tentatively placed there. If not, the algorithm moves to your #2, then #3, and so on until you’re matched or your list is exhausted.

This means ranking an “attainable” program at #1 instead of your dream program doesn’t increase your chances of matching at that attainable program. The algorithm would have placed you there anyway if your dream program didn’t work out. All you’ve done is eliminate any possibility of matching somewhere better.

It’s tempting to rank a program highly if you think they like you. It can be a pride issue , we all want to say we matched at our number one choice. We’re also more likely to feel positive emotions in an environment where we think people like us.

But sorting out how you feel versus how you think the program feels is exactly the wrong approach. As a published review in Medical Science Educator put it, game-theoretic analysis shows that applicants are “unequivocally unable to ‘game the system’ by misstating their preferences. Telling the truth is the optimal strategy.”

Rank honestly. The Nobel Prize-winning math is on your side.

2. Myth: Only rank your favorite programs.

Truth: A shorter rank list increases the risk of not matching.

In the context of myth number 1, it’s imperative to point out that it’s still important to rank as many acceptable programs as possible. If you’d be okay matching there, rank it.

The NRMP’s own data backs this up definitively. Their “Impact of Length of Rank Order List on Match Results” report , which tracks ROL length trends from 2006 to 2025 , consistently shows that matched applicants have longer rank lists than unmatched applicants. For U.S. MD seniors, the average ROL length for matched applicants has increased 62.9% over the past 20 years, though it’s still well below the 20 ranks included in the standard Match registration fee.

A shorter list doesn’t make the algorithm “try harder” at your top choices. That’s not how it works. Each additional program on your list is essentially a free insurance policy that has zero effect on whether you match at #1.

With every program you choose not to rank, ask yourself: Is not matching a risk I am willing to take?

3. Myth: Rank every program you interviewed at.

Truth: Only rank programs where you would be content to train.

Now here’s where things get nuanced, because this myth seems to contradict the one above. But there’s a critical distinction.

Putting a program on your rank order list (ROL) creates a binding commitment if you match there. If you are opening an envelope on Match Day, you have to accept that the name on the piece of paper can be any program from your rank list.

Ask yourself this tough question for every program you rank: Would I rather not match than be obligated to train at this location?

If the idea of improving your skills, completing research, or pursuing another endeavor is more favorable than being matched at that program, don’t rank it. But be honest with yourself here , for most applicants, going unmatched carries enormous financial and career costs. The bar for “I’d rather not match” should be genuinely high.

The takeaway from myths 2 and 3 together: rank as many programs as you can genuinely see yourself training at, but don’t include programs that would make you miserable for the next 3-7 years just to pad the list.

4. Myth: Programs can see where you ranked them.

Truth: Rank order lists are completely confidential.

This one fuels a lot of unnecessary anxiety. Some applicants worry that ranking a program low will “offend” them or hurt their chances. It won’t , because the program will never know where you ranked them unless you tell them.

The NRMP explicitly states that rank order lists are confidential and are only used by the algorithm. Programs are prohibited from asking applicants to disclose ranking preferences under the NRMP’s code of conduct. At no point during the algorithm’s processing do applicants or programs learn about tentative matches being made. Both parties are only informed of the final result.

What about post-interview communication? Programs may reach out and say something like, “We’d love to see your name on Match Day.” As one former residency program director noted to the AMA, those sorts of vague comments are “very open to interpretation.” Take them with a grain of salt, and don’t let them override your true preferences.

5. Myth: The algorithm is rigged to favor programs over applicants.

Truth: The algorithm has been applicant-proposing since 1998 , for over 25 years.

This conspiracy theory has remarkable staying power, especially in online forums. And it’s not entirely baseless as a historical concern. Prior to 1995, the NRMP matching algorithm actually did favor residency programs, proposing matches based on programs’ rank order lists rather than applicants’.

But that changed. The algorithm became applicant-proposing in the late 1990s, meaning your preferences drive the process, not the programs’. It’s been this way for over two decades.

Here’s the part that should put this to rest: the student-proposing version of the algorithm is mathematically proven to produce the best possible outcome for students among all stable matchings. Researchers have even tried to find exploitable cracks in the system. The conclusion, as one group of investigators put it, is that the “game” applicants are playing is “more solitaire than poker.”

There’s no opponent to outsmart. Just rank honestly.

6. Myth: It’s okay to make last-minute changes.

Truth: Rushing the process leads to rash decisions and regret.

Ranking your residency programs is a big decision. It’s important to weigh multiple factors to ensure you get a result you’re satisfied with come Match Day.

Rushing the process or making last-minute changes , especially based on a flattering email from a program or a panicked late-night conversation with a classmate , can lead to regret. You want to come out of Match Week, no matter the result, knowing you gave it your all and put time and care into every aspect of the residency application process, including your ROL.

The NRMP itself advises applicants not to wait until the last minute to enter their ROL, noting that servers may be overloaded and working slowly near the deadline. Build your list thoughtfully, certify it with confidence, and resist the urge to second-guess at the eleventh hour.

7. Myth: Going with your gut is better than a systematic approach (or vice versa).

Truth: It’s a combination of both, but most importantly, it’s something no one else can decide for you.

Some people argue for the twenty-column spreadsheet, with each column weighted to create a score assigned to each program. Others say they follow their gut instinct or “sense of belonging” and rank with their hearts.

The truth is, your decision must be based on a combination of factors. If your partner has a job in a certain area, perhaps location is the most important thing, and you can adapt to other factors. If you want to buy a house for your family instead of living in a one-bedroom apartment with a roommate, maybe you will choose a small town instead of a big city. And if you simply want to pursue the best quality training possible, rank programs with that top-of-mind.

Take time to figure out what is important to you, and own it without regrets. Put in the research and be honest with yourself about what matters most.

Read our guide: How to Make Tough Decisions — 7 Strategies for Better Decision Making.

A Quick Note on Couples Matching

If you’re couples matching, there’s one additional nuance worth understanding. The algorithm processes couples’ paired rank lists as a unit. If you and your partner don’t obtain a match as a couple, the algorithm will not process your lists separately to find individual matches. This means both partners need to carefully coordinate their paired rank lists, and strategic considerations , like including “No Match” as an option for one partner at certain combinations , require real planning.

For more on navigating the couples match, read our Couples Match Guide.

Making the Decisions That Are Right for You

There is no doubt that making your rank list is a daunting task. The unknowns are scary. But here’s the good news: the algorithm is literally designed to get you the best outcome it can based on your honest preferences. You don’t need to play poker with it. You just need to be honest with yourself.

So be brave, be thoughtful, and remember to hit “Certify” before the deadline.

If you’re still in the midst of applying to residency, save our ERAS Residency Application Guide.